Psoriasis--verruca--epithelioma : a sequence / by James C. White.

  • White, James C. (James Clarke), 1833-1916.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Psoriasis--verruca--epithelioma : a sequence / by James C. White. Source: Wellcome Collection.

    5/12 (page 167)
    American Dermatological Association in its combined returns of five yeai s, a ratio equal to 8.28 per cent. It is, therefore, a matter of fre¬ quent observation, and no disease of the integument presents a more regular course, a greater uniformity and simplicity of lesions, and a more indifferent relation to the economy as a whole than it. It might have been predicted in every individual case before this, as far as the recorded experience of dermatologists reaches, that the disease could lead to no serious results directly or indirectly. Let us consider what is the nature of this affection, and what connection there may be between it and the other two processes with which it is so intimately associated in this case. Psoriasis has been generally regarded as an inflammatory process of the skin, and in most works on dermatology it is placed among the inflammatory or exudative affections. Hebra, how¬ ever, in his latest edition, laid greater stress upon its relation to simple epidermal hyperplasy, and his son, in his recent work—Die krankhaften Ver'dndernngen der Haut—describes it as a local epithelial hyperplasy produced by the quantitative increase and qualitative (alienation) change in all the epidermal strata. Dr. A. R. Robinson, of New York, was among the first to recognize the essential anatomical nature of the disease, and to show by thorough microscopical study that it is not primarily an inflammatory affection of the papillary layer of the corium. In the begin¬ ning the process is simply one of hyperplasy of the Malpighian layer, and the apparent hypertrophy of the papillee is the result of the extension downwards of the newly-formed rete cells, the intermediate papillae not being elevated above the general level of their tips in the surrounding healthy skin. Later the bloodvessels of the papillae become dilated, serum and white corpuscles exude, and these conditions with the great increase of epidermal development give rise to the redness and thickening of the skin. The important points established by Dr. Robinson’s investigations are that the hyperplasy precedes the hyperaemia, so that any inflammatory phenomena in the tissues of the cutis are to be regarded as secondary and not essential features of the disease.1 Of the reality and intensity of the inflammation of the cutaneous tissues which not unfrequently accompanies the disease there can be no question. This is of most common occurrence in the early stages of universal psoriasis of rapid evolution, but occasion¬ ally accompanies individual cases throughout their course. The dermatitis at times amounts to a true eczema, and often demands special treatment for its relief before the proper and more stimulating applications for the psoriasis can be employed. Auspitz, in his System der Hautkrankheiten (Wien, 1881), has con¬ tributed a valuable chapter to our knowledge on the classification of affec¬ tions of the epidermis, among which he places psoriasis. This seventh